title: Myocardial deformation and rotational profiles in mitral valve prolapse.
abstract: We studied whether evaluation of overall left ventricular (LV) and left atrial (LA) mechanics would be useful to detect subclinical dysfunction in patients with mitral valve prolapse (MVP), mitral regurgitation (MR), and normal LV ejection fraction (EF). Fifty consecutive patients (27 men, mean age 61 ± 19 years) with MVP, MR, and normal systolic function (LVEF ≥60%) were prospectively enrolled and compared with 40 age- and gender-matched healthy subjects (22 men, mean age: 59 ± 16 years). At baseline, 2-dimensional and color-flow Doppler transthoracic echocardiography were performed for MR quantification and analysis of left-chambers mechanics. Patients were divided into groups by severity of MR: mild (n = 14), moderate (n = 19), and severe (n = 17). Left ventricular dimensions, volume and mass, and LA area and volume indices were significantly increased in patients with moderate and severe MR compared with control subjects. Circumferential strain, basal/apical rotations, and twist were significantly enhanced in patients with moderate MR compared with controls; with the exception of basal rotation, they decreased in those with severe MR. Furthermore, LA strain and untwisting rate were progressively and significantly reduced from normal subjects to patients with severe MR. Effective regurgitant orifice area and MR vena contracta were significantly related to most systolic and diastolic function parameters and LA volume as well as LA strain and LV untwisting rate in all patients. In conclusion, cardiac mechanics indices, particularly LA deformation and LV rotational parameters, could help unmask incipient myocardial dysfunction in patients with MVP, especially in those with severe MR and yet normal LVEF.
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Todaro
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà-Piccione
authors.forename: Alessandra
authors.initials: A
authors.lastname: Caprino
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.forename: Lilia
authors.initials: L
authors.lastname: Oreto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Khandheria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D018618:Echocardiography, Doppler, Color; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012399:Rotation; D012720:Severity of Illness Index; D016277:Ventricular Function, Left